title: Variations between world regions in individual health: a multilevel analysis of the role of socio-economic factors.
abstract: BACKGROUND
  Living in a particular region might affect health. We aimed to assess variations between regions in individual health. The role of socio-economic factors in the associations was also investigated.
  
  
  METHODS
  World Health Survey data were analysed on 220 487 individuals. Main outcomes included self-reported health, health complaints and disability. The main predictor variable was a modified regional classification of countries. Multilevel logistic regression was used to assess associations between individual health and regions, while accounting for individual and country-level socio-economic factors, notably occupation, education, national income and female literacy.
  
  
  RESULTS
  Individual health varied significantly between regions. For instance, compared with Western Europeans, Southern Asians and Western Africans reported poorer health, the odds ratios (ORs) being 2.05 [95% confidence interval (CI) 1.31-3.23] and 1.88 (95% CI 1.26-2.81), respectively. Accounting for socio-economic factors attenuated or, in a few cases, reversed the associations. For example, the OR for Southern Asia and Western Africa respectively became 0.94 (95% CI 0.37-2.37) and 0.77 (95% CI 0.26-2.25). Individuals from Central Europe and the Former Soviet Union were the most likely to report poor health, OR 1.92 (95% CI 1.07-3.44) and OR 4.17 (95% CI 1.91-9.10) respectively. Overall, men were less likely than women to report poor health.
  
  
  CONCLUSIONS
  Substantial regional variations in individual health exist, only partly explained by socio-economic factors. Additional policy and health research are needed to investigate Central Europe and Former Soviet Union rates that consistently lag behind Latin America, Asia and Africa.
authors.affiliation: Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.witvliet@amc.uva.nl
authors.forename: Margot I
authors.initials: MI
authors.lastname: Witvliet
authors.forename: Anton E
authors.initials: AE
authors.lastname: Kunst
authors.forename: Karien
authors.initials: K
authors.lastname: Stronks
authors.forename: Onyebuchi A
authors.initials: OA
authors.lastname: Arah
mesh_terms: D000349:Africa; D001208:Asia; D017691:Caribbean Region; D003430:Cross-Sectional Studies; D005060:Europe; D005260:Female; D014943:Global Health / Q000592:standards* / Q000706:statistics & numerical data; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008297:Male; D055361:Multilevel Analysis; D012959:Socioeconomic Factors; D013020:South America; D014586:USSR; D014944:World Health Organization